Mathematical modeling as the method of choice of the pharmacoeconomically reasonable regimen of the combined therapy of type 2 diabetes

Abstract

The pharmacoeconomic study has been conducted with the purpose of scientific substantiation of the regimens of combined therapy of type 2 diabetes mellitus (DM). The research subjects were 1792 inpatient medical histories of the patients with type 2 DM. These patients were treated at the Vinnytsia regional endocrinology clinic, endocrinology departments of the Khmelnytsky and Ternopol regional hospitals in 2011-2013. The following methods were used in the research: frequency analysis, ATC/DDD-analysis, cost-effectiveness analysis, cost-utility analysis, sensitivity analysis, mathematical modeling. As a result of the frequency analysis conducted it has been found that the following regimens of pharmacotherapy are the most frequently used: metformin + glimepiride applied in 45% of cases, gliclazide + metformin – in 14.5% of cases, metformin + glibenclamide – in 6.1% of cases. ATC/DDD-analysis has shown that the cost of DDD of metformin + glimepiride is ranged from 2.70 (Dianormet t.850 mg No.30 + Diapiryd 3 mg t.№30) tо 8.88 UAH (Siofor 500 mg t. No.60 + Amaril 2 mg t. No.30), metformin + gliclazide – from 3.29 (Diaformin 850 mg t. No.60 + Diaglizyd MR 30 mg t. No.60) to 9.43 UAH (Siofor 500 mg t. No.60 + Diabeton MR 60 mg t. No.30), metformin + glibenclamide – from 1.98 (Diaformin 850 mg t. No.60 + Glibenclamide 5 mg t. No.100) to 6.20 UAH (Siofor 500 mg t. No.60 + Maninil 3,5 mg t. No.120). The results obtained indicate the cost-effective and cost-utility advantages of the regimen of the combined therapy metformin + glibenclamide. The sensitivity analysis has shown stability of the pharmacoeconomic study results. The mathematical model of the "Decision Tree" that graphically shows the results of pharmacoeconomic studies has been constructed.